Many tests and surgeries simply are a waste

USA Today (Society for the Advancement of Education), Feb, 2005

Provocative observations on the health care system, including the assertion that everyday life is becoming "medicalized" have been made in The Last Well Person: How to Stay Well Despite the Health-Care System by Nortin M. Hadler, professor of medicine and microbiology-immunology in the University of North Carolina School of Medicine and an attending rheumatologist at UNC Hospitals.

Among his observations are that heart bypass surgery usually is a waste of money, time, and energy and, like screening for prostate cancer, does more harm than good; testing for breast cancer is not always useful or effective; and nothing of substance is accomplished by treating the cholesterol or bone density of well people.

Hadler's book looks at the "when" rather than the current emphasis on "what" causes death. He examines the literature of social epidemiology to discern factors that might assist individuals in coping with life's unavoidable challenges rather than assume that all of these are diseases to be treated. It is not a compendium of answers, or even questions. "It is a series of object lessons designed to teach the well reader how to make informed decisions about [his or her] own health care."

Hadler makes his case against heart bypass surgery by illustrating that three clinical trials have shown 97% of patients who undergo the surgery receive no survival benefit as a result. Yet, about 500,000 heart bypass surgeries are performed nationwide each year.

Hadler cites studies concluding that surgery for prostate cancer does not prolong the life of men who have it, but simply reduces the likelihood that prostate cancer will be the direct cause of death. On breast cancer, Hadler maintains that early detection only benefits women whose breast cancer is a threat to their longevity. Early detection provides far less benefit as a woman gets older.

"If you are approaching old age, or you are young but already burdened with diseases actively assaulting your longevity, breast cancer is less a malignant specter and, in all probability, the least of your problems," Hadler contends.